Healthcare Provider Details

I. General information

NPI: 1619702727
Provider Name (Legal Business Name): JORY OWENS-HOACH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2024
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 E 20TH ST
FARMINGTON NM
87401-8905
US

IV. Provider business mailing address

1408 8TH ST
ALAMOGORDO NM
88310-5115
US

V. Phone/Fax

Practice location:
  • Phone: 866-273-2451
  • Fax:
Mailing address:
  • Phone: 866-273-2451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: